The condition known as an ingrown toenail is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into the side of the nail fold. While ingrown nails can occur in both the nails of the hand and feet, they occur most commonly with the toenails. A true ingrown toenail is caused by the actual penetration of the flesh by a sliver of nail.
The most common cause of an ingrown toenail is cutting one's toenail too short. Other causes can be from wearing socks and shoes that are tight or short. Trauma can also cause ingrown toenails. This includes stubbing your toe or having an object fall on your toenail. Fungal infection of the toenail can also cause an ingrown toenail condition.
Symptoms of an ingrown nail include pain along the margins of the nail, worsening of pain when wearing tight footwear, and sensitivity to pressure of any kind. Indeed, bumping of an affected toe can produce sharp, even excruciating, pain as the tissue is punctured further by the nail. By the very nature of the condition, ingrown nails become easily infected unless special care is taken to treat the condition early on and keep the area clean. Signs of infection include redness and swelling of the area around the nail, drainage of fluid, and watery discharge tinged with blood. The main symptom is swelling at the base of the nail on the side the nail is ingrown.
Ingrown toenails that are left untreated can eventually lead to osteomyelitis, which is an infection in the bone. This serious infection can be especially severe if you have diabetes or circulatory problems in your lower extremities.
Treatment of ingrown toenails depends upon the severity of the condition. Any signs of pain, redness, swelling of the toe or infection should mean a trip to the podiatrist. The doctor may try to recommend simple treatment such as soaking your foot in Epsom salts or in an antibacterial solution. Treatment may also include trimming of the ingrown toenail. However, many times this is only a temporary solution, as ingrown toenails tend to reoccur and become chronic.
A more permanent treatment is to perform what is known as a P & A procedure (phenol and alcohol). This procedure is also called a partial matrixectomy. This procedure eliminates the nail matrix, which is the area from where the ingrown toenail grows. The nail matrix is located behind and underneath the cuticle.
In the P & A procedure, a podiatrist first injects a local anesthetic into the toe to numb it. He next applies a toe tourniquet to prevent bleeding while the procedure is being performed. The ingrown toenail is then removed. The amount of nail that is removed is approximately one millimeter or slightly more. In order to remove the nail matrix, a strong acid such as phenol is used in the procedure.
The procedure comprises inserting a cotton tip applicator into a bottle of phenol and then inserting it under the skin until it comes in contact with the nail matrix. This procedure destroys the matrix area in order to permanently and selectively ablate the matrix that is manufacturing the ingrown portion of the nail (i.e., the nail margin). Thereafter, the area is saturated with an alcohol in order to irrigate the area and for removing any remaining phenol at the surgical site.
In particular, a cotton tip applicator is saturated with phenol. The applicator is then inserted under the skin until it comes into contact with the nail matrix. The applicator is then continuously rotated on the matrix for approximately thirty (30) seconds. The treatment comprises a total of three applications for a combined total of approximately ninety (90) seconds. The surgical site is then irrigated with alcohol to flush out the remaining phenol. A topical antibacterial ointment or cream may thereafter be applied followed by the application of a dry sterile dressing. The toe tourniquet is then removed.
In general, the point of the P & A procedure is to ensure that the nail does not grow back where the matrix has been cauterized/ablated so the chances of further ingrowths are substantially reduced. Occasionally, of course, the ingrown toenail can reoccur which would then require the procedure to be performed again.
The disadvantage to the above described surgical procedure is that the phenol usually also comes into contact with the skin and nail bed, which causes burning and damage to these two soft tissue structures. If this can be eliminated or significantly reduced, the surgical site will heal more quickly. Accordingly, it would be desirable to provide an improved treatment method which overcomes this disadvantage.